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Reducing CAUTI in Patients with Acute Urinary Retention in the Critical Care Setting: A Pilot Study with Electronic Medical Record Analytics

      Highlights

      • Patients with AUR require specific strategies for reducing CAUTI risk.
      • An algorithm for AUR management decreased dwell times of IUCs placed for AUR.
      • An algorithm for AUR management increased utilization of medications to treat AUR.
      • Nurse education using multiple methods aids successful implementation.
      • Provided consistent documentation, EMR extracts effectively monitor implementation.

      Abstract

      Background

      This study implemented and evaluated an algorithm protocol for management of indwelling urinary catheters (IUCs) among patients treated for acute urinary retention (AUR) in an intensive care unit. The algorithm protocol (1) instituted in and out catheterization before placing an IUC for retention; (2) encouraged more consistent use of medications for AUR; and (3) provided for prompt removal of IUCs placed for AUR.

      Methods

      An uncontrolled pre- and post-test intervention approach was used to assess the impact of the algorithm on the treatment of AUR. Bivariate and multivariate analyses assessed data collected using two approaches: (1) electronic extracts from the electronic medical record (EMR) versus (2) manual chart reviews.

      Results

      Findings suggest that the intervention decreased indwelling IUC days by 1.93 average days and increased medication prescription rates. An EMR extract identified fewer catheters per patient pre-intervention than a manual chart review, but otherwise the differences observed in the EMR extract and manual chart review were insignificant.

      Conclusions

      Implications for practitioners and administrators are that the algorithm protocol may reduce CAUTI risk and – provided consistent EMR documentation – EMR extracts may represent an efficient and effective approach for monitoring data when spreading the intervention.

      Graphical abstract

      Keywords

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